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Vakili K, Fathi M, Yaghoobpoor S, Sayehmiri F, Nazerian Y, Nazerian A, Mohamadkhani A, Khodabakhsh P, Réus GZ, Hajibeygi R, Rezaei-Tavirani M. The contribution of gut-brain axis to development of neurological symptoms in COVID-19 recovered patients: A hypothesis and review of literature. Front Cell Infect Microbiol 2022; 12:983089. [PMID: 36619768 PMCID: PMC9815719 DOI: 10.3389/fcimb.2022.983089] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
The gut microbiota undergoes significant alterations in response to viral infections, particularly the novel SARS-CoV-2. As impaired gut microbiota can trigger numerous neurological disorders, we suggest that the long-term neurological symptoms of COVID-19 may be related to intestinal microbiota disorders in these patients. Thus, we have gathered available information on how the virus can affect the microbiota of gastrointestinal systems, both in the acute and the recovery phase of the disease, and described several mechanisms through which this gut dysbiosis can lead to long-term neurological disorders, such as Guillain-Barre syndrome, chronic fatigue, psychiatric disorders such as depression and anxiety, and even neurodegenerative diseases such as Alzheimer's and Parkinson's disease. These mechanisms may be mediated by inflammatory cytokines, as well as certain chemicals such as gastrointestinal hormones (e.g., CCK), neurotransmitters (e.g., 5-HT), etc. (e.g., short-chain fatty acids), and the autonomic nervous system. In addition to the direct influences of the virus, repurposed medications used for COVID-19 patients can also play a role in gut dysbiosis. In conclusion, although there are many dark spots in our current knowledge of the mechanism of COVID-19-related gut-brain axis disturbance, based on available evidence, we can hypothesize that these two phenomena are more than just a coincidence and highly recommend large-scale epidemiologic studies in the future.
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Affiliation(s)
- Kimia Vakili
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Fathi
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Yaghoobpoor
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sayehmiri
- Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yasaman Nazerian
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ashraf Mohamadkhani
- Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pariya Khodabakhsh
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gislaine Z. Réus
- Translational Psychiatry Laboratory, Graduate Program in Health Sciences, University of Southern Santa Catarina (UNESC), Criciúma, SC, Brazil
| | - Ramtin Hajibeygi
- Department of Cardiology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Mostafa Rezaei-Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Adamec I, Brecl Jakob G, Drulović J, Sellner J, Bilić E, Sitaš B, Bilić H, Tamaš O, Budimkić M, Veselinović N, Horvat Ledinek A, Jerše J, Gomezelj S, Hauer L, Krbot Skorić M, Habek M. Transverse myelitis following COVID-19: Insights from a multi-center study and systematic literature review. J Neurol Sci 2022; 443:120463. [PMID: 36334503 DOI: 10.1016/j.jns.2022.120463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION We aimed to provide insights into transverse myelitis (TM) following COVID-19 by analyzing cases treated at tertiary care neurology centers and a systemic review of the literature. METHODS The retrospective observational multi-center study was conducted at the four university neurology departments in Croatia, Slovenia, Serbia, and Austria. We searched for acute myelitis cases that occurred during or after COVID-19. A systemic review of the literature on COVID-19 and transverse myelitis was performed. RESULTS We identified 76 persons with TM associated with COVID-19, 13 from the multi-center study and 63 from the literature review. Most of the participants (55.6%) had an intermediate latency, 25.4% had short and 19% long latency from COVID-19 symptoms to TM. The clinical presentation consisted of the typical TM signs. More than half of the participants had inflammatory changes in the CSF, with rare patients having intrathecal OCB synthesis and positive serology for anti-MOG or anti-AQP4 antibodies. Persons with autonomic symptoms and CSF pleocytosis were significantly more common to have an intermediate latency of 8 to 21 days from COVID-19 to TM (p = 0.005 and p = 0.003; respectively). According to logistic regression analysis, only participants with lesions evident on spinal cord MRI compared to normal spinal cord MRI had reduced risks for poor recovery. >80% of participants were treated with a combination of corticosteroids and intravenous immunoglobulins or plasma exchange with 73% having incomplete recovery. CONCLUSION Our study further characterizes clinical, laboratory, and MRI features, as well as treatment of TM associated with COVID-19.
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Affiliation(s)
- Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Gregor Brecl Jakob
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
| | - Jelena Drulović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | - Johann Sellner
- Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.
| | - Ervina Bilić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Barbara Sitaš
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
| | - Hrvoje Bilić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia.
| | - Olivera Tamaš
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | - Maja Budimkić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | - Nikola Veselinović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; University Clinical Center of Serbia, Clinic of Neurology, Belgrade, Serbia.
| | | | - Jana Jerše
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
| | - Sarah Gomezelj
- University Medical Centre Ljubljana, Department of Neurology, Ljubljana, Slovenia.
| | - Larissa Hauer
- Christian Doppler Medical Center, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; Faculty of Electrical Engineering and Computing, University of Zagreb, Zagreb, Croatia.
| | - Mario Habek
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Autonomic Nervous System Disorders, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
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Pagenkopf C, Südmeyer M. A case of longitudinally extensive transverse myelitis following vaccination against Covid-19. J Neuroimmunol 2021; 358:577606. [PMID: 34182207 PMCID: PMC8223023 DOI: 10.1016/j.jneuroim.2021.577606] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 01/07/2023]
Abstract
Background Longitudinally extensive transverse myelitis (LETM) is a rare subtype of transverse myelitis (TM) that potentially results in relevant disability. Apart from association to neuromyelitis optica and other chronic demyelinating diseases of the central nervous system, many other aetiologies are known. Particularly systemic infections and vaccination are considered potential triggers for immune mediated inflammation of the spinal cord. In the course of the current Covid-19 pandemic several cases of TM following Covid-19 infection have been described. Here we present a case of LETM following vaccination against Covid-19 with AZD1222, AstraZeneca. An extensive diagnostic work up was performed to rule out alternative causes, including prior and current Covid-19 infection. Conclusion To our knowledge this is first case of LETM possibly related to Covid-19 vaccination that is published after marketing authorisation of various vaccine candidates.
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Affiliation(s)
- Claudia Pagenkopf
- Klinikum Ernst von Bergmann, Department of Neurology, Charlottenstrasse 72, 14467 Potsdam, Germany.
| | - Martin Südmeyer
- Klinikum Ernst von Bergmann, Department of Neurology, Charlottenstrasse 72, 14467 Potsdam, Germany; Department of Neurology, Medical Faculty, University Düsseldorf, Düsseldorf, Germany.
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Maltezou HC, Pavli A, Tsakris A. Post-COVID Syndrome: An Insight on Its Pathogenesis. Vaccines (Basel) 2021; 9:497. [PMID: 34066007 PMCID: PMC8151752 DOI: 10.3390/vaccines9050497] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/08/2021] [Accepted: 05/10/2021] [Indexed: 12/22/2022] Open
Abstract
Post-COVID syndrome is increasingly recognized as a new clinical entity in the context of SARS-CoV-2 infection. Symptoms persisting for more than three weeks after the diagnosis of COVID-19 characterize the post-COVID syndrome. Its incidence ranges from 10% to 35%, however, rates as high as 85% have been reported among patients with a history of hospitalization. Currently, there is no consensus on the classification of post-COVID syndrome. We reviewed the published information on post-COVID syndrome, putting emphasis on its pathogenesis. The pathogenesis of post-COVID syndrome is multi-factorial and more than one mechanism may be implicated in several clinical manifestations. Prolonged inflammation has a key role in its pathogenesis and may account for some neurological complications, cognitive dysfunction, and several other symptoms. A multisystem inflammatory syndrome in adults (MIS-A) of all ages has been also described recently, similarly to multisystem inflammatory syndrome in children (MIS-C). The post-infectious inflammatory pathogenetic mechanism of MIS-A is supported by the fact that its diagnosis is established through serology in up to one third of cases. Other pathogenetic mechanisms that are implicated in post-COVID syndrome include immune-mediated vascular dysfunction, thromboembolism, and nervous system dysfunction. Although the current data are indicating that the overwhelming majority of patients with post-COVID syndrome have a good prognosis, registries to actively follow them are needed in order to define the full clinical spectrum and its long-term outcome. A consensus-based classification of post-COVID syndrome is essential to guide clinical, diagnostic, and therapeutic management. Further research is also imperative to elucidate the pathogenesis of post-COVID syndrome.
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Affiliation(s)
- Helena C. Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, 11523 Athens, Greece
| | - Androula Pavli
- Department of Travel Medicine, National Public Health Organization, 11523 Athens, Greece;
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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Pavli A, Theodoridou M, Maltezou HC. Post-COVID Syndrome: Incidence, Clinical Spectrum, and Challenges for Primary Healthcare Professionals. Arch Med Res 2021; 52:575-581. [PMID: 33962805 PMCID: PMC8093949 DOI: 10.1016/j.arcmed.2021.03.010] [Citation(s) in RCA: 165] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/31/2021] [Indexed: 12/16/2022]
Abstract
Post-COVID syndrome also known as long COVID refers to symptoms persisting for more than three weeks after the diagnosis of COVID-19. We reviewed the current evidence on post-COVID syndrome, focusing on its clinical manifestations and addressing the challenges for its management in primary healthcare. The incidence of post-COVID syndrome is estimated at 10–35%, while for hospitalized patients it may reach 85%. Fatigue is the most common symptom reported in 17.5–72% of post-COVID cases, followed by residual dyspnea with an incidence ranging from 10–40%. Mental problems, chest pain, and olfactory and gustatory dysfunction may affect up to 26, 22 and 11% of patients, respectively. More than one third of patients with post-COVID syndrome have pre-existing comorbidities, hypertension and diabetes mellitus being the most common. Beyond the prolonged duration of symptoms, the scarce published data indicate that most patients with post-COVID syndrome have a good prognosis with no further complications or fatal outcomes reported. Given the clinical spectrum of patients with post-COVID syndrome, most of them will be managed by primary healthcare professionals, in conjunction with pre-existing or new co-morbidities, which, in turn, may increase the burden of COVID-19 on primary healthcare. In conclusion approximately 10% of patients with COVID-19 may have symptoms persisting beyond three weeks, fulfilling the criteria of post-COVID syndrome. Primary healthcare professionals have a key role in the management of patients with post-COVID syndrome. Research is needed to elucidate the pathogenesis, clinical spectrum, and prognosis of post-COVID syndrome.
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Affiliation(s)
- Androula Pavli
- Department of Travel Medicine, National Public Health Organization, Athens, Greece
| | - Maria Theodoridou
- First Department of Pediatrics, University of Athens, Athens, Greece
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
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